President Obama and Hillary Clinton love to talk about the “20 million people” who’ve allegedly been added to the health insurance rolls under Obamacare. But in truth, a lower percentage of Americans have private health insurance now than in 2007, even though Obamacare is the law. This is according to the federal government’s own figures. According to the Centers for Disease Control and Prevention, 67% of those living in the United States had private health insurance in 2007. Now, as of 2015, only 66% have private health insurance.

Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients.

The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans — including Blue Shield of California — that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

The Obama administration is considering changes to how these dollars are allocated in the state and federal exchanges, but critics say the proposed modifications don’t go far enough.

Health care experts on both sides of the aisle projected the next Congress may tie reforms to Obamacare to other legislative efforts, speaking Tuesday at a National Coalition on Health Care forum. Conservatives on the panel suggested any negotiations would be tied to how willing both parties are to compromise. Douglas Holtz-Eakin, president of the American Action Forum, suggested GOP priorities such as tax reform or adjusting how the federal government addresses poverty could address health care in some way if the next administration and Senate are willing to acknowledge them and make trades. Joseph Antos, a health analyst at the American Enterprise Institute, agreed, saying adjustments would be possible based on how much the incoming administration is willing to negotiate with Congress.

Some health insurers say they’re paying too much to rival Blue Cross Blue Shield plans under a key pillar of the federal health law designed to compensate insurers that take on sicker and more expensive patients. The critics’ chief complaint is that the Affordable Care Act’s risk-adjustment program unfairly rewards health plans—including Blue Shield of California—that have excess administrative costs and higher premiums. That comes at the expense of more efficient, lower-priced plans in the individual market, they say.

Doctor and hospital switching has become a recurring scramble as consumers on the individual market find it difficult or impossible to stay on their same plans amid rising premiums and a revolving door of carriers willing to sell policies. “In 2017, just because of all the carrier exits, there are going to be more people making involuntary changes,” said Katherine Hempstead, a senior adviser at the Robert Wood Johnson Foundation, a New Jersey philanthropy. “I would imagine all things being equal, more people are going to be disappointed this year versus last year.”

Nearly 30 million American adults remain uninsured. Despite the Affordable Care Act’s vast—and growing—cost to taxpayers, it has failed to place the U.S. on the road to near-universal health insurance coverage. To deliver coverage that is more affordable and attractive to middle-class Americans, structural reforms to the ACA are urgently needed. Until then, America’s middle class will suffer the ACA’s high costs without enjoying its benefits.

If we are to make healthcare affordable for everyone, the answer is not going to come from a President Hillary Clinton or a President Donald Trump. Instead, the solution can be found if we send healthcare back to the states where experimentation and innovative public policies can take place focusing on utilization and waste in healthcare.

It is there that we can look to states already on the move. Florida, Georgia, Tennessee and Alabama are considering a bold concept to reduce waste by reducing the need to practice of wasteful, defensive medicine.

Defensive medicine is any type of medical practice to avoid litigation such as tests, scans, medications and procedures.

Minnesota’s Democratic governor said Wednesday that the Affordable Care Act is “no longer affordable” for many, a stinging critique from a state leader who strongly embraced the law and proudly proclaimed health reform was working in Minnesota just a few years ago.

Gov. Mark Dayton made the comments while addressing questions about Minnesota’s fragile health insurance market, where individual plans are facing double-digit increases after all insurers threatened to exit the market entirely in 2017. He’s the only Democratic governor to publicly suggest the law isn’t working as intended.